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Answer: Although cancer registries typically expect five years to elapse before a diagnosis of cancer is removed, that does not apply to physician ICD-9 coding.
If the patient is cancer-free, a personal history of cancer diagnosis should be used for any procedure subsequently reported (typically, once the global period of the procedure that removed the cancer has ended). The American Hospital Association's coding clinic guidelines state that "history of cancer" diagnoses should be used once the tumor has been removed, treatment has ended and there is no evidence of recurrence.
For example, a patient who underwent a sigmoid resection (44140, colectomy, partial; with anastomosis) returns to the surgeon for surveillance endoscopy either 45330 (sigmoidoscopy, flexible; diagnostic, with or without collection of specimen[s] by brushing or washing [separate procedure]) or 45378 (colonoscopy, flexible, proximal to splenic flexure; diagnostic, with or without collection of specimen[s] by brushing or washing, with or without colon decompression [separate procedure]) to determine if the margins remain cancer-free. Code V10.05 (personal history of malignant neoplasm; large intestine) should be used in this case, rather than 153.3 (malignant neoplasm; sigmoid colon) or any other malignant neoplasm code.
If the patient had a sigmoid cancer resection and the margins remained clear but the mesenteric lymph nodes were positive, the pretest diagnosis should be reported as personal history of colon cancer, and the posttest diagnosis reported as the lymphatic malignancy (196.2, secondary and unspecified malignant neoplasm of intra-abdominal lymph nodes). If the patient receives chemotherapy, use 196.2 for the primary diagnosis; list V10.05 as the secondary diagnosis. |
